Bloodwork 31yr Old - Worried About Results

Pharma / TRT Testosterone Replacement
1

Guys,

I came off a cycle of Test E and Tren E late last year. I used HCG throughout cycle, along with a comprehensive PCT (6wk updated version of Dr Scally’s protocol). It has been 5 months since I have come off and I have had some serious issues with depression and motivation.

I recently came out of an awful relationship, and while I have had tremendous difficulty getting over her and dealing with my emotions, I simply put it down to the fact it was a rough breakup.

After seeing the doc, he ordered some bloods and the results seem worrying:

Estradiol (E2): 83 (7.6 - 42.6) pmol/l (HIGH)
Prolactin: 323 (65 - 260) mU/l (HIGH)

LH: 5.3 (1.5 - 9) U/l
FSH: 12.4 (1 - 14) U/l (Fairly high)

Total Testosterone: 11.1 (9.3 - 34.6) nmol (Low)
Free Testosterone: 16.6 (15.8 - 83.8) pmol (Low)
SHBG: 23 (13 - 71) nmol

Symptons:

Depression
Lethargy
Zero libido
Anxiety

From my research and rudimentary understanding, it seems my high E2 and prolactin levels could be suppressing my testosterone levels. The scary thing is that my elevated FSH and prolactin could be pointing to a pituitary adinoma…

I have a follow up consultation to be refered to a specialist but I know this will take time. Any advice would be great.

Cheers guys.

2

Update:

Ihave an appointment to schedule a MRI this week. Does anyone have a view on this? I have scoured this forum and online looking for other cases that mirror my results but cannot seem to find any that are close enough to give me confidence in a comparison.

I realise this might on first glance appear the wrong forum for this post, however if it is indeed a pituitary adenoma, then I assume TRT is going to have to be an option. I am worried as the results seem to potentially also point to primary hypogonadism… I want kids someday, and I sorely hope this hasn’t destroyed my chances of that happening.

Again, any advice would be appreciated.

3

Some testicular cancers produce FSH and you should get your testes examined.

Need you age and more details.

Please read these stickies:

  • advice for new guys
  • things that damage your hormones

SHBG does not agree with high E2 level. Something is not as it seems.

List all medications, Rx and OTC, supplements, alcohol intake, rec drugs.

Add TSH, fT3, fT4, AST, ALT, CBC to lab work.

4

Thank you for your reply, stats below as per first sitcky:

-age 31
-height 5’10
-waist 31inch
-weight 170lb
-describe body and facial hair - Abundant. Facial hair thick, dark. Grows rapidly.
-describe where you carry fat and how changed - midsection
-health conditions, symptoms [history] - Had mumps at 20yr old. Right testicle swole to the size of an orange. Returned to normal size following rx drugs (can’t recall which)
-Rx and OTC drugs - Modafinil 5 days a week. Multi vit. 4k iu vit D. BCAA. On and off use of D aspartic acid and creatine. No tablets or powders for 3 days before test.
-describe diet - 10g BCAA 6AM (Pre workout), 10g BCAA 7.30am (post workout). Lean meal of half chicken, veggies, avocardo for lunch. Protein shake and cut meats in afternoon. Eve meal of chicken / fish veggies rice.
-describe training - 3 to 4 x a week, 6am start, strength / BB no cardio. Cycle to work and gym and back daily (15mins each way to work)
-testes ache, ever, with a fever? - No

Will go back to docs and order the requested additional bloods asap.

5

Would you recommend a short course of exemestane (or another ai) in combination with dostinex to reduce e2 and prolactin?

6

With that diet, total cholesterol may be too low. Please do fasting cholesterol. Cholesterol is the foundation for sex hormones and cortisol and for vit-D3 creation.

Are you using sea salt and not iodized? Iodine deficiency can cause all kinds of problems. You can check your oral body temperature, when you wake AND afternoon as per the thyroid basics sticky.

7

KSman I really appreciate your input. I will pick up an oral thermometer tomorrow. I do not really tend to add additional salt (iodized or otherwise) to anything. Historically, I have supplemented with lugols iodine solution, however I have not used for over a year now. I’ll order some.

8

So my consultant has cancelled my appointment and has said I am much better suited to speak to the endocrinology department when they can finally fit me in next week.

The trouble is, although they have the results in front of them, they flat out state they refuse to provide any treatment to lower my E2 or prolactin levels until they have found the root cause of the problem, or in case “the problem fixes itself”…

Next week (assuming my appointment is confirmed) they will run further bloods including thyroid checks.

My question is in the interim, I am concerned about my E2 and prolactin. Should I self medicate with exemestane and dostinex to bring things at least down to normal before the other bloods and MRI?

9

I had horrible anxiety until I brought my estrogen down. Night and day difference. Not only that but I sleep a ton better and I’m not so bitchy. I would HIGHLY suggest getting that taken care of.

10

For six months I feel like I have completely lost a sense of my self. Every morning I fight, I get up and beat myself into a determined mindset to fight this no matter what. Yet day by day, every evening it slowly chips away at me as I lose emotional control and the depression kicks in.

I’m so desperate to feel normal I am considering TRT options with the doc but I want kids one day, and I want to return to homeostasis, not rely on exogenous hormones. This is the hardest thing I’ve ever had to deal with, and I feel nothing like the happy confident man I used to be even prior to cycling.

11

I feel your pain, I was in a similar situation a few years ago, a girl messed with my head and it was like I was this needy nerd in an emotional state(that’s how i view myself at that time)whereas she had the control, it was like roles reversed, my god I didn’t want to be that man…powerless, oh and women love power my friend…

I’m on TRT now, my free test level was similar to yours, now it’s treble that and boy do i feel better and in control, a different man, hold my head up and worry about little. Though I have posted a thread on here which KSMan has kindly advised as my e2 level is very high - I still have ED problems and need to sort this of course, but I can tell you that Test over everything is king imo…

I’m certainly not advising TRT, it’s a huge step, this site is wonderful for help and i just wished I’d have found it earlier because who knows…but I was told that once your test level is low it’s hard to raise it significantly to make this huge lift in mood and well being feeling…

Good luck for the future…

12

I really appreciate the responses. To say things have been tough lately would be a gross understatement. TRT is indeed a big step. Even if I am deemed a candidate by the specialist, there are many things to consider. Primarily for me, as I have said is children. Trying not to let my estradiol speak for me, however it’s the one thing above all else in my future that I am truly looking forward to.

I have managed to secure an appointment with an endocrinologist on Wednesday. He briefly said on the phone he would schedule the necessary tests and bloodwork but did not provide any specifics.

I picked up a oral thermometer today and just tested. It’s 18:30 here and managed a reading of 98.6F which according to the thyroid sticky is ok. I am always warm (often too hot) and get flushed easily. I will check first thing tomorrow and monitor.

13

Results from second bloodwork came back today. Endocrinologist said that while my Testosterone is low, he would expect my LH and FSH to be higher for a classic case of primary hypogonadism. He said mine is an unusual case and he will present my results to his colleagues tomorrow to see what their opinion is??

Do my results look that out of the ordinary??

In summary:

Testosterone still low at 7.09 (8.6-29 nmol/l)
Prolactin still high at 21.3 (4.0-15.2 ug/l)
Annoyingly, looks like he didn’t test E2 this time however one could assume it’s still elevated from last time given high prolactin
He didn’t test SHBG this time either???

LH and FSH seem elevated
LH: 6.9 (1.7-8.6 IU / L)
FSH: 12 (1.5-12.4 IU / l)

Thyroid function “perfectly fine” according to Dr
TSH: 1.79 (0:30 to 3:18 mu/l)
FT3 (triiodothyronine, free): 4.3 (4.1-6.7 pmol/l)
FT4 (thyroxine, free): 16.3 (12.3-20.2 pmol/l)

HGH and IGF seem high and Cortisol seems very high
Neutrophils low and Lymphocytes high?? (I hope this is due to the fact i had a cold the week before and nothing more serious?)
Vit D, B12 etc all seem ok

Full Results (I had to run this through Google Translate so apologies if some things don’t make sense):

Sex hormones
LH: 6.9 (1.7-8.6 IU / L)
FSH: 12 (1.5-12.4 IU / l)
Prolactin: 21.3 (4.0-15.2 ug / l) *** *** HIGH
Testosterone: 7:09 (8.6-29 nmol / l) *** *** LOW

Thyroid
TSH: 1.79 (0:30 to 3:18 mu / l)
FT3 (triiodothyronine, free): 4.3 (4.1-6.7 pmol / l)
FT4 (thyroxine, free): 16.3 (12.3-20.2 pmol / l)

Insulin and growth
HGH: 1.3 (12:02 to 1:23 ug / l)
IGF1: 216.9 (96.4-227.8 ug / l)

Adrenal cortex
ACTH: 36 (<46 ng / l)
Cortisol: 740 (171-536 nmol / l)

Blood Status
H globin: 151 (134-170 g / l)
H matokrit: 0:44 (0400-0500 l / l)
Erythrocytes: 4.74 (4.2-5.7 t / l)
MCV: 92.8 (80-100 fl)
MCH: 31.9 (26-34 pg)
MCHC: 343 (310-360 g / l)
RDW: 13.4 (11.0-14.8%)
Platelets (automatic): 206 (143-400 g / L)
Leukocytes: 3.43 (3.0-9.6 g / l)
Blood count
Neutrophils (automatically): 1:38 (1:40 to 8:00 g / l) *** *** LOW
Monocytes (automatically): 12:26 (0.16-0.95 g / l)
Eosinophils (automatically): 0.07 (0.00-0.70 g / l)
Basophils (automatically): 0.02 (0:00 to 0:15 g / l)
Lymphocytes (automatically): 1.7 (1:50 to 4:00 g / l)
IG abs. (Automatically): 0.01 (0:00 to 0:03 g / l)
IG% (automatically): 0.3 (0.0-0.5%)
NRBC abs. (Automatically): 0 (g / l)
NRBC (automatically): 0 (/ 100 Lc)
Neutrophils Total (mik.): 1.49 (1:40 to 8:00 g / l)
Monocytes (mik.): 00:19 (0.16-0.95 g / l)
Eosinophils (mik.): 0.06 (0.00-0.70 g / l)
Basophils (mik.): 0 (0:00 to 0:15 g / l)
Lymphocytes (mik.): 1.69 (1:50 to 4:00 g / l)
Neutrophils Total (mik.): 43.3 (40.0-74.0%)
Neutrophils Stabker. (Mic.): 3.7 (0.0-20.0%)
Neutrophils Segmentk. (Mic.): 39.6 (30.0-50.0%)
Monocytes (mik.): 5.5 (3.4-9.0%)
Eosinophils (mik.): 1.8 (0.0-7.0%)
Basophils (mik.): 0 (0.0-1.5%)
Lymphocytes (mik.): 49.4 (19.0-48.0%) *** *** HIGH
Plasma cells (MIC.): 0 (0-0.5%)
Blasts (mik.): 0 (0%)
Promyelocytic: 0 (0%)
Myelocytes: 0 (0.0-0.0%)
Metamyelocytes: 0 (0%)
Other (s comment.): 0 (%)
Erythroblasts: 0 (/ 100 Lc)

H MOSTASE INVESTIGATIONS
Global tests
Quick (machine) #: 121 (> 70%)
INR #: 1 (<1.2)

Electrolyte and water balance
Sodium: 143 (136-145 mmol / l)
Potassium: 4.3 (3.3-4.5 mmol / l)
Calcium, total: 2:29 (2:09 to 2:54 mmol / l)
Phosphate: 0.97 (0.87-1.45 mmol / L)

Kidney
Creatinine: 77 (62-106 pmol / l)

Proteins
Albumin: 42 (40-49 g / l)

Enzymes
ALT (GPT) Alanine Aminotransf .: 46 (<50 U / l)
Alk phosphatase. 54 (40-129 U / L)

Diabetes and Energy Metabolism
Glucose spontaneously Fluoridpl .: 5.1 (<11.1)
HbA1c n.NGSP: 5.2 (4.4-5.7%)
HbA1c after IFCC: 33 (25-39 mmol / mol)

Lipid metabolism and atherosclerosis
Cholesterol, total: 4.2 (<5.0 mmol / l)
HDL cholesterol: 1:05 (> 1.0 mmol / l)
non-HDL cholesterol: 3.2 (<4.0 mmol / l)
. Chol / HDL cholesterol ratio: 4 (<5.0)
LDL-cholesterol: 2.6 (<3.0 mmol / l)
Triglyceride: 1.31 (<1.7 mmol / l)

Iron metabolism
Ferritin: 324 (30-400 ug / l)

Vitamins
Folic acid: 9.7 (> 4.0 ug / l)
Vitamin B12: 416 (180-914 ng / l)

14

Just an update on my situation here. Several tests later and the conclusion is I am primary hypogonadal. I have had a sperm test and population is very low and 0pct viable.

Doctor initially prescribed HCG and HMG for 3 months and a repeat sperm-check after this point to see if I am producing enough to produce a viable sample for cryopreservation. On speaking with him, he is also comfortable prescribing Nebido at the same time.

The thing is, my LH and FSH levels are already quite high, and I have read that HCG & HMG is only really a suitable treatment for infertility in secondary hypogonadal cases. I am keen to use HCG and HMG anyway in an attempt to improve levels, but I don’t know if this will help to improve my current condition.

Can anyone provide any advice here? The doctor seems very flexible on his recommendation and is open to experimentation.

15

Another update. Went to see endo today and he gave me a prescription for nebido.

He said he discussed my case again with his colleagues and they agreed they would not provide hcg / hmg as my case is primary hypogonadism.

I am concerned about taking nebido alone without hcg or an ai to control e2. I plan on having blood tests every 6 weeks but the doc won’t check e2 levels and only really seems concerned with hematocrit levels.

Ksmann, do you have any advice here?

I have an appointment with another specialist in my home country in a month or so, and I plan on raising my concerns there. Is there any advice anyone can give?